Provider Demographics
NPI:1972517175
Name:OSMAN, MOHAMEDNOOR A (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMEDNOOR
Middle Name:A
Last Name:OSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 ISAAC WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-5954
Mailing Address - Country:US
Mailing Address - Phone:916-714-4245
Mailing Address - Fax:916-714-4245
Practice Address - Street 1:1800 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6019
Practice Address - Country:US
Practice Address - Phone:916-714-4245
Practice Address - Fax:916-714-4245
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85472207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A854720Medicaid
CA00A854720Medicare PIN
CA00A854721Medicare PIN
CAI21052Medicare UPIN
CA00A854724Medicare PIN